Racial and Ethnic Disparities in Influenza Vaccination Among Elderly Adults

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2005 Jun 21

PMID 15963166

Citations 26

Authors

Maria C Rangel

Victor J Shoenbach

Kristen A Weigle

Vijaya K Hogan

Ronald P Strauss

Shrikant I Bangdiwala

Affiliations

Soon will be listed here.

Abstract

Objectives: To examine whether access to care factors account for racial/ethnic disparities in influenza vaccination among elderly adults in the United States.

Design: Indicators of access to care (predisposing, enabling, environmental/system, and health need) derived from Andersen's behavioral model were identified in the National Health Interview Survey questionnaire. The relationship of these indicators to influenza vaccination and race/ethnicity was assessed with multiple logistic regression models.

Main Results: Significant differences in vaccination were observed between non-Hispanic (NH) whites (66%) and Hispanics (50%, P<.001) and between NH whites (66%) and NH blacks (46%, P<.001). Controlling for predisposing and enabling access to care indicators, education, marital status, regular source of care, and number of doctor visits, reduced the prevalence odds ratios (POR) comparing Hispanics to non-Hispanic whites from 1.89 to 1.27. For NH blacks, controlling for access to care indicators changed the POR only from 2.24 (95% CI, 1.9 to 2.7) to 1.93 (95% CI, 1.6 to 2.4).

Conclusions: This study confirmed the existence of sizable racial/ethnic differences in influenza vaccination among elderly adults. These disparities were only partially explained by differences in indicators of access to care, especially among non-Hispanic blacks for whom large disparities remained. Factors not available in the National Health Interview Survey, such as patient attitudes and provider performance, should be investigated as possible explanations for the racial/ethnic disparity in influenza vaccination among non-Hispanic blacks.

Citing Articles

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Racial and Ethnic Disparities in Adult Vaccination: A Review of the State of Evidence.

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Schmid P, Rauber D, Betsch C, Lidolt G, Denker M PLoS One. 2017; 12(1):e0170550.

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References

Weinick R, Zuvekas S, Cohen J . Racial and ethnic differences in access to and use of health care services, 1977 to 1996. Med Care Res Rev. 2000; 57 Suppl 1:36-54. DOI: 10.1177/1077558700057001S03. View

Anderson R . Deaths: leading causes for 2000. Natl Vital Stat Rep. 2002; 50(16):1-85. View

Simonsen L, Clarke M, Schonberger L, Arden N, Cox N, Fukuda K . Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. J Infect Dis. 1998; 178(1):53-60. DOI: 10.1086/515616. View

Corbie-Smith G . The continuing legacy of the Tuskegee Syphilis Study: considerations for clinical investigation. Am J Med Sci. 1999; 317(1):5-8. DOI: 10.1097/00000441-199901000-00002. View

LaVeist T, Nickerson K, Bowie J . Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000; 57 Suppl 1:146-61. DOI: 10.1177/1077558700057001S07. View

Hayward R, Bernard A, Freeman H, Corey C . Regular source of ambulatory care and access to health services. Am J Public Health. 1991; 81(4):434-8. PMC: 1405059. DOI: 10.2105/ajph.81.4.434. View

Mac Donald R, Baken L, Nelson A, Nichol K . Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients. Am J Prev Med. 1999; 16(3):173-7. DOI: 10.1016/s0749-3797(98)00159-7. View

Barker W . Excess pneumonia and influenza associated hospitalization during influenza epidemics in the United States, 1970-78. Am J Public Health. 1986; 76(7):761-5. PMC: 1646876. DOI: 10.2105/ajph.76.7.761. View

. Design and estimation for the National Health Interview Survey, 1995-2004. Vital Health Stat 2. 2001; (130):1-31. View

10.

Fiscella K, Franks P, Doescher M, Saver B . Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care. 2001; 40(1):52-9. DOI: 10.1097/00005650-200201000-00007. View

11.

Nichol K, Margolis K, Wuorenma J, von Sternberg T . The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med. 1994; 331(12):778-84. DOI: 10.1056/NEJM199409223311206. View

12.

Sullivan K, Monto A, Longini Jr I . Estimates of the US health impact of influenza. Am J Public Health. 1993; 83(12):1712-6. PMC: 1694912. DOI: 10.2105/ajph.83.12.1712. View

13.

Schneider E, Cleary P, Zaslavsky A, Epstein A . Racial disparity in influenza vaccination: does managed care narrow the gap between African Americans and whites?. JAMA. 2001; 286(12):1455-60. DOI: 10.1001/jama.286.12.1455. View

14.

Barker W, Mullooly J . Influenza vaccination of elderly persons. Reduction in pneumonia and influenza hospitalizations and deaths. JAMA. 1980; 244(22):2547-9. View

15.

Schur C, Bernstein A, Berk M . The importance of distinguishing Hispanic subpopulations in the use of medical care. Med Care. 1987; 25(7):627-41. DOI: 10.1097/00005650-198707000-00006. View

16.

Nicholson K, Kent J, Hammersley V, Cancio E . Acute viral infections of upper respiratory tract in elderly people living in the community: comparative, prospective, population based study of disease burden. BMJ. 1997; 315(7115):1060-4. PMC: 2127683. DOI: 10.1136/bmj.315.7115.1060. View

17.

Hutchison B . Measurement of influenza vaccination status of the elderly by mailed questionnaire: response rate, validity and cost. Can J Public Health. 1989; 80(4):271-5. View

18.

. Influenza and pneumococcal vaccination levels among adults aged > or =65 years--United States, 1997. MMWR Morb Mortal Wkly Rep. 1998; 47(38):797-802. View

19.

Mark T, Paramore L . Pneumococcal pneumonia and influenza vaccination: access to and use by US Hispanic Medicare beneficiaries. Am J Public Health. 1996; 86(11):1545-50. PMC: 1380687. DOI: 10.2105/ajph.86.11.1545. View

20.

Gross P, Hermogenes A, Sacks H, Lau J, Levandowski R . The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature. Ann Intern Med. 1995; 123(7):518-27. DOI: 10.7326/0003-4819-123-7-199510010-00008. View